The extension-adduction test in chronic tennis elbow: Soft tissue components and joint biomechanics

Lateral elbow pain in 25 patients with chronic tennis elbow was reproduced by passive extension-adduction (EA) tests. Standard EA tests were performed with the addition of passive wrist flexion and extension and also with the forearm in the pronated position. These modifications were chosen in order to evaluate the effect on pain of a change in the lateral articular and extra-articular tissues. Performing the EA test in pronation rather than supination produced no significant change. However, both wrist flexion and extension.produced significant increases in pain. These results suggest increased tension in lateral structures relevant to tennis elbow and point to a useful addition to the standard EA test. The increase in elbow pain on wrist extension suggests that abnormalities of neural tension may contribute to pain. The results also indicate that a good comparable sign may be demonstrated with the forearm either pronated or supinated.